Provider Demographics
NPI:1306383351
Name:WELTON, ELISE I (PSYD)
Entity Type:Individual
Prefix:DR
First Name:ELISE
Middle Name:I
Last Name:WELTON
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22 WATER ST
Mailing Address - Street 2:APT 411
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:02141-1257
Mailing Address - Country:US
Mailing Address - Phone:551-206-3504
Mailing Address - Fax:
Practice Address - Street 1:22 WATER ST
Practice Address - Street 2:APT. 411
Practice Address - City:CAMBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:02141-1257
Practice Address - Country:US
Practice Address - Phone:551-206-3504
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-30
Last Update Date:2017-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10521103TC0700X
NY021466-1103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical